A Deep Dive into the Medical Applications of CBD for Epilepsy Treatment

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In the present world, there has been a rising interest surrounding the utilisation of CBD to treat diseases. In fact, CBD has been largely used in the medical care of patients who are diagnosed with epilepsy. Nonetheless, there have also been several common misunderstandings surrounding the consequences of taking CBD. This is caused by the lack of public understanding and acknowledgement.

Hence, let’s familiarise ourselves with CBD in a logical step-by-step manner, whereby we will delve deeper into understanding how CBD plays a role in relieving epileptic symptoms, as well as discuss the most recent findings from experimental investigations conducted by researchers.

CBD and epilepsy - what are they?

What is epilepsy?

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To explain it in a simple manner, epilepsy can be defined as a neurological disturbance of our central nervous system (CNS). This leads to unusual brain activity that produces nasty seizures, abnormal sensations, behaviour, and sometimes, the individual may lose their consciousness of their surroundings. Nonetheless, the good thing is that this mental disorder is not a contagious one and the patient cannot develop this from an existing mental condition. 

Still, the concerning news is that anybody would be able to develop epilepsy, regardless of their age, gender, race, or ethnicity. Specifically, epilepsy could take place due to an abnormality in the patient’s wiring network within their brain. Conversely, a lack of balance between neurotransmitters (meaning nerve signalling chemicals) might also be a plausible culprit of epilepsy. In the extreme cases where the patient is very unlucky, their epileptic syndrome may be a result of these two factors combined. In the worst case scenarios, the most-difficult-to-treat epileptic conditions are associated with a higher risk of the patient dying prematurely.

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One of the most distinctive symptoms of epilepsy would be the patient experiencing various seizures. These are generated by inconsistent electrical impulses in the individual’s brain, and this may spread across their body and be responsible for unmanageable physical movements and/or loss of awareness at specific periods of time. The seizure symptoms might differ between varying patients. Nevertheless, for a doctor to properly diagnose a patient with epilepsy, these patients will be required to have observed at least two seizures that were not triggered by any external factors.

In contrast, most of the anti-seizure medicines exert their effects by lowering the activity of excitatory nerves that are located in the patient’s brain. The disappointing outcome is that most epilepsy medications are not super effective (should they even be) within nearly one-third of the patients who suffer from this mental disorder. For instance, Huntsman et al. (2019) suggested that up to 30% of the patient subjects that they have investigated continued to suffer from seizures despite having received the necessary medical attention as well as anticonvulsant drugs.

What is cannabidiol?

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Medical marijuana is also called medical cannabis, which are the substance that can be obtained from the Cannabis sativa plant for medical purposes. Within medical cannabis, there are more than a hundred variants of substances known as cannabinoids, whereby they can exert its therapeutic benefits on the body cells (including brain cells). The two main cannabinoids used in medicine are namely, tetrahydrocannabinol (THC) and cannabidiol (CBD). They can both be found within the resin of the C. sativa plant. Even though CBD and THC come from the same plant sources, it is very important for you to know that CBD is a non-psychoactive compound, thus it is proposed to be the key contributor to most of the medical benefits that are tied with medical cannabis. On the other hand, THC is a psychoactive compound found within cannabis. Therefore, THC is usually the causative agent for the “high” feeling often linked to recreational drug consumers. As a result, the legal quantity of THC permitted within a CBD product would be 0.2%, as explicitly stated by the Home Office.

Despite the negligible amount of THC allowed within CBD products, this should not be a huge influence on the quality of anti-seizure drugs. This is due to several animal studies showing that THC generally had a weaker influence in reducing seizures as well as other epileptic symptoms when it is compared with CBD directly. Furthermore, the main side effects caused by the “high” feeling becomes the key deterrent for most pharmaceutical companies from investing in any research and development (R&D) efforts of a drug that contains THC. As a result, this would essentially explain why pharmaceutical CBD for epilepsy treatment usually has negligible or minute quantities of THC.

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In fact, on the 25th of June 2018, the United States’ Food & Drug Administration (FDA) have approved the Epidiolex® oral solution for the treatment of seizure symptoms which are associated with two different variants of epilepsy conditions in patients who are above the age of two years old. These two forms of epilepsy are namely, Lennox-Gastaut syndrome and Dravet syndrome. To provide a brief summary, Epidiolex is a purified (i.e. over 98% of it is oil-based) CBD extract taken from the C. sativa plant. It is produced by Greenwich Biosciences, a U.S.-based company of GW Pharmaceuticals, and it is available for sale in a predetermined dosage for the patients to consume. Epidiolex was the first-ever FDA-approved anti-seizure therapy to help relieve patients from the symptoms of Dravet syndrome. It also acts as a novel therapeutic option for young children and people who suffer from these types of epileptic disorders.

It is also something noteworthy for you to know that Lennox-Gastaut syndrome and Dravet syndrome are rare versions of epilepsy, both of which are notoriously hard for physicians to treat. In particular, Dravet syndrome is a severe form of epilepsy that could take place during an individual’s childhood, thereby causing neurological disturbances. According to the reports published by the Genetic and Rare Diseases Information Center of the National Institutes of Health, this syndrome is caused by a mutation in the SCN1A gene. Henceforth, children diagnosed with Dravet syndrome typically have frequent and often multiple types of seizures, like focal seizures that emerge in a specific area of our brain together with generalised convulsions. Conversely, Lennox-Gastaut syndrome is deemed to be a rare form of epilepsy as it emerges only in one to five out of every 100 children. More than 75% of these individuals diagnosed with this epileptic syndrome are likely to have tonic seizures. This means that their bodies, arms, and/or legs could become rigid and stiff out of a sudden. Not to mention, the majority of these epileptic patients, particularly children, are likely to struggle with learning as they may face problems in the development of their motor skills.

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Epidiolex was experimented on 516 patients who are suffering from either Lennox-Gastaut syndrome or Dravet syndrome under three randomized and placebo-controlled studies. The findings from these investigations showcased that patients who were placed under the add-on therapy with the medication had demonstrated a reduced frequency of seizure symptoms overall, as opposed to the other group who was assigned to take a placebo. Nevertheless, there are numerous side effects that the patient may expect when consuming Epidiolex. The common ones that emerge amongst people who take Epidiolex include having trouble falling asleep, a reduction in appetite, suffering from diarrhoea, tiredness, a weak body, rash, and infections. 

The emerging popularity of taking CBD to treat epilepsy

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Using the information provided by the World Health Organization, epilepsy has impacted more than 50 million people globally. Around 80% of the people suffering from epilepsy originate from low- and middle-income countries. The risk of premature death amongst epileptic patients has been predicted to be approximately three times higher than the normal healthy population. In general, epilepsy is one of the most typical neurological conditions worldwide. However, notably, it is suggested that almost 70% of the patients diagnosed with epilepsy may possibly be relieved from their symptoms, should they be given the right diagnosis and required treatment.

Still, cannabidiol (CBD) has been the centre of media attention for it is a potential medicine to treat epilepsy. Even though research is in its early stages at-present, there are various government-approved clinical trials that are studying the efficacy of CBD as a likely treatment for different types of seizures. Overall, researchers are in the midst of determining to what extent CBD is able to reduce the frequency of seizures in patients with epilepsy, together with how safe CBD is for consumption.

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The availability of CBD in the United Kingdom (UK)

Medical cannabis has been made legal in the UK and it is usually sold as CBD oil. Hence, specialist physicians are allowed to prescribe it, under specific circumstances, as a type of therapy. Specifically, the UK has put forward certain exemptions for the applications of medical cannabis to treat severe epilepsy, chemotherapy-related illness, as well as multiple sclerosis (MS). Even with that, do remember that medical cannabis still holds the Class B illegal drug status should it be under the possession and/or is sold by a person for recreational use.

The origins using CBD for therapeutic applications

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The historical use of the cannabis plant by humans goes way back to the start of the human race on Earth. This plant was initially postulated to come from Central Asia or from the foothills of the Himalayas, in which cannabis was cultivated in China at first (due to its rich fibre and seed content) as well as India (for the production of resin).

To give you a short history lesson, the first experiments conducted on the medical applications of cannabis have actually started during the ruling period of the Chinese Emperor Shen Nung (which is approximately 2,700 B.C.). Even with that, as a result of the negative public opinions surrounding cannabis, which took place due to the rising drug abuse issues during the 1970s, cannabis has been prohibited for use as a medication and in research. Nonetheless, once researchers slowly demonstrated the lack of psychoactive activity presented by CBD unlike THC, the previous research on CBD started to resurface. Therefore, this introduces novel areas of research on medical cannabis, such as its applications for epilepsy treatment.

The association between the endocannabinoid system and the function of CBD

The endocannabinoid system (ECS) is a complex and highly intricate cell-signalling network that was discovered by scientists back in the early 1990s, when they were studying the effects of THC within our body.

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Scientists have successfully segregated the different types of phytochemicals that come from the cannabis plant. These can be named as phytocannabinoids, in which “phyto” can be defined as “plant. In essence, these phytocannabinoids are almost the same as our body’s very own version of cannabinoids, whereby these are known as endocannabinoids. Precisely, “endo” means that the cannabinoid “comes from our own body”. After several years of experimental work, they were finally in the position to conclude that these endocannabinoids act as a key player in the regulation of neuronal firing during the process of synaptic transmission. Specifically, neurons usually generate electrochemical signals that influence other neurons, glands, and muscles to produce our feelings, thoughts, as well as actions.

There are two critical endocannabinoid receptors found in our endocannabinoid system, namely the CB1 and CB2 receptors. The CB1 receptors are generally situated in the central nervous system, whereas the CB2 receptors are typically present in the peripheral nervous system, especially within immune cells. As a result, the cannabinoids can then interact with either one of these two receptors, and so their biological functions are reliant on the location of this receptor in our body as well as the kind of endocannabinoid that interacts with it.

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How can epilepsy be treated using CBD?

During an epileptic seizure, there will be a disruption in the regular neuronal activity and its pattern. Hence, this results in the individual experiencing atypical feelings, behaviours, as well as emotions. In particular, the neurons may fire signals as frequent as 500 times each second. This is much faster in comparison to the normal frequency. In specific people, this event might only take place occasionally; whereas for others patients, this event could even occur up to hundreds of times every day!

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Nonetheless, this should not worry you too much. This is because there has been evidence proposing that the substances found in medical cannabis could be used as anti-seizure drugs (also known as anticonvulsants drugs). Some of the earliest proofs came from animal studies which were conducted during the 1970s, in which both the CBD and THC oils were experimented on and have been shown to possess significant anticonvulsant effects in mice.

In our present world, there have been a number of scientists who brought forward the notion that CBD plays a huge role in influencing our endocannabinoid system during the events of an epilepsy attack. In particular, CBD helps to deactivate CB1 receptors in addition to other relevant molecular components that are located within the hippocampus (that is a part of the brain).

Based on the findings from several research investigations, the cannabinoid present in common CBD oil can assist in protecting our neurons from external damages. In essence, these cannabinoids prevent any invading toxins from infecting and harming the neurons. Though bear in mind that if the toxin levels are too high, they may initiate a greater seizure rate. In addition, due to the ability of CBD in exerting a relaxing sensation, consuming CBD might help the user to control their emotions better. Hence, through the effects of these cannabinoids, CBD could assist in preventing epileptic attacks.

To what extent is CBD effective in epilepsy treatment?

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There have been multiple experimental investigations suggesting that CBD may be an effective medicine for children who are diagnosed with specific epilepsy conditions which are particularly difficult to treat. To evaluate to what extent this treatment is effective against epilepsy, researchers would often study the number of patients who have over a 50% reduction in the frequency of seizure attacks.

To start with, a meta-analysis published in the Journal of Neurology, Neurosurgery and Psychiatry was gathering scientific evidence to show that CBD is an appropriate treatment option for epilepsy, and could help to lower the rate of seizures from occurring or to stop them completely. This study consisted of the collaborative initiatives between scientists who have affiliations with the National Drug and Alcohol Research Centre in Australia, King’s College London, and several other tertiary institutions. The team looked through the data gathered from six randomized control studies in addition to 30 observational studies investigating the association between CBD treatment and epileptic attacks. Taking the results they have obtained from the available investigations, the team discovered that CBD could reduce the rate of seizures that occur and also enhance the patients’ overall quality of life. For instance, based on the data taken from two of the randomized controlled trials as well as 17 of the observational studies, the group has realised the link between taking CBD and a significant reduction in the seizure rates. In particular, they observed that around 48% of the subjects had an over 50% reduction in the total number of seizures they suffered from. Hence, the team eventually came to the conclusion that there is solid scientific evidence demonstrating a steep decrease in the frequency of seizures amongst almost 50% of the participants during this clinical trial.

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Besides that, a 2016 investigation did study on 214 people who were diagnosed with epilepsy. The subjects were assigned to take oral doses of between 2 to 5mg of CBD every day together with their original anti-epilepsy medications. The scientists then took note of the participants over the next 12 weeks, recording any negative side effects in addition to observing the rate of their seizure attacks. They soon discovered that the participants experienced a 36.5% decrease overall in the number of seizure attacks they had per month. However, 12% of the total number of participants have also declared to have suffered serious and uncomfortable side effects throughout the investigation.

Other than that, a meta-analysis which was published in 2018 and evaluated the applications of CBD  to help treat epilepsy mentioned that CBD is an effective medication against specific forms of epilepsy. Furthermore, they also placed forward the notion that CBD-rich extracts are typically more effective than CBD isolates. For this study, the group analysed the data taken from 11 different experiments involving a total participant count of 670, all who have received medical attention for over half a year on average. This meta-analysis specifically chose to focus on three different forms of childhood-linked seizures, specifically Dravet syndrome, Lennox-Gastaut syndrome, and epileptic conditions that were caused by a deficiency in CDKL5. The scientists were hoping to determine the effectiveness, optimal drug dosage, in addition to the side effects associated with using CBD as a treatment. In addition to that, the team also initiated further studies on the differences between the efficacy of CBD-rich extracts in comparison to CBD isolates when treating epilepsy. They eventually noted down that 71% of the participants who consumed CBD-rich extracts had lower seizure occurrence compared to the 46% of those who took CBD isolates instead. Nonetheless, both CBD-rich extracts and CBD isolates have helped in lowering the number of seizures by 50% for approximately 40% of the subjects. Therefore, this brings about the idea that both forms of CBD products can be highly effective treatment options.

Moreover, a study analysing Lennox-Gastaut syndrome, which was published in the New England Journal of Medicine in 2018, investigated 250 participants whose ages ranged between two to 55 years old in addition to having at least drop seizures each week. Each subject was randomly given either a lower or higher CBD dose (this was highly dependent on the subject’s body weight) or a placebo over a time period of 14 weeks. They found out that the overall average reduction in the frequency of drop seizures attacks taking place throughout the experiment period was nearly 42% for the group that was allocated to be given the higher CBD dose. This was followed by 37% for the lower CBD dose group, and then a 17% reduction for the group who received the placebo.

How can we consume CBD safely?

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CBD is available to be consumed in multiple different forms, thereby permitting users to tailor their preferred method of consumption to their specific requirements. Such examples of these CBD products include CBD oils and tinctures, in which the liquids are infused with CBD and are usually consumed sublingually (i.e. placed under the consumer’s tongue) using a dropper. The key concept behind this method of consumption is that our oral mucosa is filled with tiny capillaries, which will thus allow a faster absorption of these compounds. As a result, the CBD oil will be able to exert their effects fairly quickly. A notable example of such a product include Epidiolex, which is made available as an oral solution (i.e. in a liquid form), and the recommended dosage would be dependent on the patient’s body weight. This is due to children and adult patients who are diagnosed with either Dravet syndrome or Lennox-Gastaut syndrome may sometimes have significant problems when trying to consume this medication as a result of their challenges in swallowing, having changes in their behaviour or even possible cognitive problems. Besides that, capsules and pills are also popular options for people who want to take CBD. In particular, capsules and pills have been largely utilised during the systemic treatment of seizure-related disorders and digestive problems. But, it is crucial to always remember that the key disadvantage with taking the capsule forms of CBD would be the delayed time taken for the medical effects to take place because these capsules would need to undergo the process of digestion first.

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Overall, it is extremely critical to understand that different individuals are likely to react differently to CBD. Hence, you should always begin with a low dosage before increasing your dose slowly as you proceed with your treatment regimen. There may also be slight variations in terms of the quantity of CBD between all the different versions of CBD products, so a detailed and comprehensive background check is necessary if you were to try out a new CBD brand or if you are planning to change your method of taking CBD.

Why should  this be important to us?

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Epileptic seizures can significantly disrupt an individual’s life. As a matter of fact, from the moment the seizures are triggered, the patients would ultimately lose control of their entire body and thereby potentially incur further injuries. Additionally, the patient could end up facing a continuous series of migraines due to having a number of consistent epileptic seizure attacks. To reduce these negative consequences, the patients would have to be prescribed with the appropriate anti-epileptic drugs to assist them with their seizure management. However, these treatment regimens would typically come with highly undesirable side effects. As a result, many patients are now looking for an alternative form of treatment to help them manage their epileptic conditions.

As CBD comes from a natural plant, CBD oil would not be filled with any additives and so it is definitely not classified as a synthetic product. Hence, CBD oil is an organic substance and one of the most potent drugs that is made available in the epilepsy treatment market in our world today.

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Future perspectives

Does CBD have an influence on epilepsy treatment?

It is now fairly clear that cannabis has a plethora of scientifically-backed therapeutic benefits, particularly in the treatment and management of epileptic conditions. The unfortunate news is that research on cannabis has been widely prohibited due to the stigma associated with its side effects (although it was mainly caused by THC) and thereby labelled as a restricted drug based on the majority of the international legislations. Nevertheless, the UK government has placed great optimism on the applications of CBD oil in the treatment of the most serious forms of epilepsy. This is shown by the government’s decision to authorise the use of CBD oil for such healthcare objectives, despite CBD oil still bearing its Class B status when it comes to recreational consumption.

Future research directions - what we still do not understand about CBD

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The majority of the previous studies have analysed medical cannabis as a type of “add-on” therapy for patients who were already prescribed with an existing anticonvulsant medication. This thereby highlights that there is still a lot that remains unknown about whether CBD functions well when it is taken on its own.

Other than that, there have been no investigations that compared CBD with other existing anti-epilepsy medications directly. Thus, we are still not clear about whether the effect and safety of CBD is much higher in comparison to other antiepileptic drugs. Besides that, even though there is a general public belief postulating that medical cannabis is highly efficacious, researchers have warned that the side effects of this drug mandates further investigation. This is because all medications could possibly have undesirable and severe side effects, and so this necessitates a great deal of caution. Do note that some of the most typical side effects of consuming CBD include drowsiness, diarrhoea, a lowered overall appetite, as well as constant tiredness.

In addition to that, the potential consequences of taking CBD together with other medicine (like anti-seizure drugs) is still widely under-studied. Bear in mind that it is highly plausible that CBD may cause an increment in the blood levels of other anti-seizure drugs, including Topamax and Onfi (clobazam), which leads to serious side effects. Therefore, you ought to always speak to your physician first if you happen to suffer from epileptic seizures and do not react well to the existing anti-epilepsy medications. The doctors could, in turn, assist you with providing a thorough explanation on your possible treatment options and give you useful tips and opinions on whether taking CBD might be a potential option to consider.

Verified by a Healthcare Professional

Anastasiia Myronenko

Anastasiia Myronenko

Anastasiia Myronenko is a Medical Physicist actively practicing in one of the leading cancer centers in Kyiv, Ukraine. She received her master’s degree in Medical Physics at Karazin Kharkiv National University and completed Biological Physics internship at GSI Helmholtz Centre for Heavy Ion Research, Germany. Anastasiia Myronenko specializes in radiation therapy and is a fellow of Ukrainian Association of Medical Physicists.